The Vital Substances of Chinese medicine

Chinese medicine describes the body as governed by five Vital Substances — Qi (vital energy), Blood (Xue), Jing (Essence), Shen (Spirit) and Jin Ye (Body Fluids). The Zang-Fu organs store, produce and regulate these substances. Disease is fundamentally understood as deficiency, excess, stagnation or misplacement of one or more of them. This page summarises each Vital Substance and the principal patterns of disharmony.

Qi (氣) — vital energy

Qi is the active, animating force of the body — the closest English analogue is “functional energy”. Qi has five core actions: moving (drives circulation, breathing, digestion, growth), warming (maintains body temperature), protecting (defends against pathogens), transforming (converts food into Blood and Qi), and holding (keeps Blood in vessels, organs in place, urine and stool in their proper transit).

Subtypes of Qi:

1. Yuan Qi (Original Qi) — inherited from parents, stored in the Kidney, the constitutional foundation
2. Gu Qi (Grain Qi) — extracted from food and drink by the Spleen and Stomach
3. Zong Qi (Gathering Qi) — formed in the chest from Gu Qi + Lung-derived Qi; powers respiration and the Heart
4. Ying Qi (Nutritive Qi) — circulates in the channels with Blood, nourishing the organs
5. Wei Qi (Defensive Qi) — circulates at the surface, protecting against external pathogenic factors; produced by the Lung

Patterns of Qi disharmony: Qi deficiency (fatigue, weak voice, shortness of breath), Qi sinking (organ prolapse, chronic loose stools), Qi stagnation (irritability, distending pain that moves), Qi rebellion (cough from rebellious Lung Qi, vomiting from rebellious Stomach Qi).

Blood (Xue, 血)

TCM Blood overlaps with the Western concept but extends further. Blood nourishes and moistens all tissues, is the material basis for the Shen (mind), and provides the substance from which menstruation occurs. Blood is produced from Gu Qi (Spleen-derived) and Kidney Essence, and circulated by Heart Qi; it is stored in the Liver.

Patterns of Blood disharmony: Blood deficiency (pale complexion, dizziness, dry hair and nails, scant periods, palpitations, insomnia), Blood stasis (fixed sharp pain, purple lips, clots in menstrual blood, dark complexion), Blood Heat (skin rashes, heavy bleeding, anxiety).

Jing (精) — Essence

Jing is the deepest, most concentrated form of bodily resource — the “constitutional capital” that governs growth, development, fertility and ageing. It is partly inherited (pre-natal Jing from parents) and partly acquired (post-natal Jing from food and life choices). Jing is stored in the Kidney.

Jing produces Marrow, fills the brain (“Sea of Marrow”), governs bones, teeth and the reproductive endocrine axis. Its progressive depletion through life is the TCM understanding of ageing. Premature or excessive Jing depletion produces premature greying, hair loss, dental problems, reduced fertility, recurrent miscarriage, developmental delay in children and cognitive decline.

Patterns of Jing disharmony are listed under the Kidney.

Shen (神) — Spirit / Mind / Consciousness

Shen is the most subtle of the Vital Substances — the seat of consciousness, awareness, cognition, sleep, dreams, memory and the “light in the eyes” that betrays a person’s vitality. Shen resides primarily in the Heart but is also distributed in the other Yin organs as the Hun (Liver), Po (Lung), Yi (Spleen) and Zhi (Kidney) — the Five Spirits.

Patterns of Shen disharmony: Shen disturbance (insomnia, anxiety, palpitations), Shen weakness (depression, listlessness, dull eyes), severe Shen disturbance in classical psychiatric presentations.

Body Fluids (Jin Ye, 津液)

Body Fluids are all the body’s normal fluids other than Blood — saliva, tears, sweat, gastric juices, joint fluid, interstitial fluid, semen-like fluids. They are categorised as Jin (thin, watery, surface fluids such as sweat and tears) and Ye (thick, deep fluids such as joint and CSF fluid). The Lung, Spleen and Kidney govern their distribution.

Patterns of Fluid disharmony: Fluid deficiency (dry skin, dry mouth, dry stools, scanty urine, dry eyes), Fluid accumulation as Dampness (heavy head, sticky stools, vaginal discharge), Phlegm (chronic cough with sputum, lumps and nodules) or Oedema (frank fluid retention).

The substances together

The Vital Substances are not independent — they continually transform into one another. Qi produces Blood; Blood houses Shen; Jing transforms into Qi and Blood. The clinical picture in any patient is always a particular configuration of the five, observed through the pulse, tongue and pattern of symptoms.